Gran CBC – Your Complete Blood Count, Explained — Madison Memorial

Blood test. Your Gran CBC (Granulocytes from your Complete Blood Count) is the result of a blood test that tells your doctor a number of things, including your cell count for each blood cell type, your concentrations of hemoglobin, and your gran CBC count. It’s a quick and easy procedure. A nurse, such as those at Madison Memorial Hospital in Rexburg, will insert a needle into the vein of your arm and draw a small sample of your blood, to be sent to the lab for analysis. You can eat and drink on the day of your test like you normally would unless you’re having some other test or procedure performed on the same day.

• Types of cells. There are three main types of cells circulating in your bloodstream – white blood cells, red blood cells, and platelets. If you have a particularly high or low count of any of these three, it could be an indicator of one or more forms of disease or infection.

• The impact of chemotherapy. Because chemotherapy can directly affect healthy cells, including the cells in your blood, your CBC is checked before each chemo treatment. In analyzing the results of your blood test, we’ll be looking for a number of other key markers, some of which may include the following:

• Granulocytes (GRAN), also known as ANC (Absolute Neutrophil Count). About two-thirds of your white blood cells have granules (small particles) in them. These cells are called granulocytes. They’re formed in your bone marrow, and they’re both short-lived and highly mobile. Of these granulocytes, the most abundant type, called neutrophils, are often the first responders to areas of inflammation within your body. They follow chemical trails to migrate through your blood vessels in order to fight directly against infections and other causes of inflammation, often within minutes of the initial trauma. So if your CBC shows an increased neutrophil count, it may be due to infection. Likewise, a low neutrophil number might indicate a weakening of your immune system.

• Hematocrit (HCT). Also called packed cell volume (PCV), this number indicates how much of your total blood volume is comprised specifically of red blood cells. A low score indicates that you might not be getting enough iron. A high score could result if you’re dehydrated, or it could indicate another condition. Normal range: 41.5%-50.4% for men, and 36.9%-44.6% for women.

• Hemoglobin. This is the protein in your blood which actually holds onto the oxygen. Your CBC measures not only the hemoglobin in your red blood cells but the overall amount of hemoglobin, in grams per deciliter, in your blood. A low number suggests the possibility of the presence of anemia. Normal range: 14-17.5 grams per deciliter (gm/dL) for men, and 12.3-15.3 gm/dL for women.

• Mean cell hemoglobin (MCH). The average amount of hemoglobin per red blood cell.

• Mean cell hemoglobin concentration (MCHC). A measure of the average concentration of hemoglobin in your red blood cells.

• Mean cell volume (MCV). The average size of a red blood corpuscle (cell). If your red blood cells are on the large side, you might be low in vitamin B12 or folates. A smaller size could point to a specific type of anemia. Normal range: 80-96.

• Platelets. Also called thrombocytes. A low volume of platelets could point to the difficulty in clotting and might be caused by any of a large number of factors. Similarly, a high platelet count could potentially be a precursor to thrombosis, in which blood clots interrupt the flow of blood in the circulatory system. Normal range: 150,000-450,000 platelets/mcL.

• Red blood cell count (erythrocytes). A low RBC could indicate iron deficiency (anemia), which could be coupled with physical weakness symptoms since red blood cells are the cells that carry oxygen from the lungs to other parts of the body. Your CBC includes analysis of the average size of your red blood cells, the amount of hemoglobin in them, and the concentration of hemoglobin among all of them.

• Red blood cell distribution width (RDW). A measurement of how much your red blood cells vary in size and weight. Certain disorders, including vitamin deficiencies and a lack of iron, can cause significant variation. Red blood cells are normally fairly consistent in their size and weight. Normal range: 4.5 million-5.9 million cells per microliter (cells/mcL) for men, and 4.1 million-5.1 million cells/mcL for women.

• Reticulocyte count. A measurement of the number of new red blood cells in your body.

• White blood cell count (leukocytes). A high WBC might mean that your body is fighting an infection. It could also indicate the possibility of the presence of leukemia. In contrast, a low WBC could mean your body is especially susceptible to infections. Normal range: 4,5000-10,000 cells per microliter (cells/mcL).

• White blood cell differential. There are five types of white blood cells: neutrophils (described above), lymphocytes, monocytes, eosinophils, and basophils. This measurement shows how many you have of each type.

Interpretation and further testing. It’s important to keep in mind that your CBC results should be properly interpreted by qualified medical professionals such as the caregivers at Madison Memorial Hospital and that any of the above-mentioned abnormalities may or may not be caused by any of the above indicators. Also, the above ranges are general, and your own gran CBC results should have a “reference range” column, which should be your primary source of understanding whether your results fall within normal levels, based on how your specific lab measures and reports on these parameters. Your doctor at Madison Memorial in Rexburg will know whether additional testing and diagnosis are merited, based on the outcome of your specific test.

• Hematocrit (HCT). Also called packed cell volume (PCV), this number indicates how much of your total blood volume is comprised specifically of red blood cells. A low score indicates that you might not be getting enough iron. A high score could result if you’re dehydrated, or it could indicate another condition. Normal range: 41.5%-50.4% for men, and 36.9%-44.6% for women.

• Hemoglobin. This is the protein in your blood which actually holds onto the oxygen. Your CBC measures not only the hemoglobin in your red blood cells but the overall amount of hemoglobin, in grams per deciliter, in your blood. A low number suggests the possibility of the presence of anemia. Normal range: 14-17.5 grams per deciliter (gm/dL) for men, and 12.3-15.3 gm/dL for women.

• Mean cell hemoglobin (MCH). The average amount of hemoglobin per red blood cell.

• Mean cell hemoglobin concentration (MCHC).  A measure of the average concentration of hemoglobin in your red blood cells.

• Mean cell volume (MCV). The average size of a red blood corpuscle (cell). If your red blood cells are on the large side, you might be low in vitamin B12 or folates. A smaller size could point to a specific type of anemia. Normal range: 80-96.

• Platelets. Also called thrombocytes. A low volume of platelets could point to the difficulty in clotting and might be caused by any of a large number of factors. Similarly, a high platelet count could potentially be a precursor to thrombosis, in which blood clots interrupt the flow of blood in the circulatory system. Normal range: 150,000-450,000 platelets/mcL.

• Red blood cell count (erythrocytes). A low RBC could indicate iron deficiency (anemia), which could be coupled with physical weakness symptoms since red blood cells are the cells that carry oxygen from the lungs to other parts of the body. Your CBC includes analysis of the average size of your red blood cells, the amount of hemoglobin in them, and the concentration of hemoglobin among all of them.

• Red blood cell distribution width (RDW). A measurement of how much your red blood cells vary in size and weight. Certain disorders, including vitamin deficiencies and a lack of iron, can cause significant variation. Red blood cells are normally fairly consistent in their size and weight. Normal range: 4.5 million-5.9 million cells per microliter (cells/mcL) for men, and 4.1 million-5.1 million cells/mcL for women.

• Reticulocyte count. A measurement of the number of new red blood cells in your body.

• White blood cell count (leukocytes). A high WBC might mean that your body is fighting an infection. It could also indicate the possibility of the presence of leukemia. In contrast, a low WBC could mean your body is especially susceptible to infections. Normal range: 4,5000-10,000 cells per microliter (cells/mcL).

• White blood cell differential. There are five types of white blood cells: neutrophils (described above), lymphocytes, monocytes, eosinophils, and basophils. This measurement shows how many you have of each type.

Interpretation and further testing. It’s important to keep in mind that your CBC results should be properly interpreted by qualified medical professionals such as the caregivers at Madison Memorial Hospital and that any of the above-mentioned abnormalities may or may not be caused by any of the above indicators. Also, the above ranges are general, and your own gran CBC results should have a “reference range” column, which should be your primary source of understanding whether your results fall within normal levels, based on how your specific lab measures and reports on these parameters. Your doctor at Madison Memorial in Rexburg will know whether additional testing and diagnosis are merited, based on the outcome of your specific test.

Understanding Blood Counts | Parts of the Body

Blood is the red fluid that goes to all parts of the body through the veins and arteries. Oxygen and nourishment are carried by the blood to all body cells. Blood is made in the bone marrow (a soft spongy tissue within our bones). Whole blood is made up of red blood cells, white blood cells, platelets and clotting factors, as well as liquid called plasma. Various substances, such as proteins, salts and sugar, are also carried within the plasma.

Children who receive chemotherapy or whose disease affects the bone marrow may have many changes in blood counts. When your child receives chemotherapy, the blood counts will be checked often.

Red Blood Cells (RBC)

RBCs contain hemoglobin, which carries oxygen to the body tissues and provides the red color of blood. A normal hemoglobin is 12 or greater. When the hemoglobin level is low, a child may become pale and tire easily, and his heart rate and respiratory rate may increase, because of a lack of oxygen. If your child’s hemoglobin is very low, he may receive a red blood cell transfusion.

Platelets

Platelets work to make clots to help stop bleeding if a blood vessel is cut or injured. A normal platelet count is 150,000 to 450,000.

When the platelet count is low, your child can bleed easily. A child with low platelet counts may bruise easily or have a bloody nose frequently. Blood in the stool and urine are less common.

If your child has a severe physical injury, and her platelet count is low, she may bleed uncontrollably. A severe headache in a child with low platelets may be a sign of bleeding in the head and needs emergency treatment.

When your child has a very low platelet count, she should avoid contact sports or any play that could cause physical injury. If your child has a nosebleed, pinch her nostrils tightly with constant pressure for at least 10 minutes while she is in a sitting position. No aspirin or ibuprofen products should be given, since they affect how platelets work in the body.

Brushing of the teeth with a soft bristle brush or sponge will help avoid unnecessary gum irritation. Other obvious bleeding should be treated first with direct pressure. If the bleeding does not stop, the physician should be notified right away. Your child may require a transfusion of platelets.

White Blood Cells (WBC)

White blood cells help us fight bacterial, fungal, viral and parasitic infections (germs). There are many different types of white blood cells, including neutrophils, eosinophils, basophils, monocytes and lymphocytes. Neutrophils, sometimes called granulocytes, kill and eat bacteria. The monocytes also fight any type of infectious agent.

There are two types of lymphocytes: B-lymphocytes and T-lymphocytes which help fight viral infections and coordinate the immune system.

A normal WBC is 5,000 to 10,000.

Absolute Neutrophil Count (ANC)

The absolute neutrophil count (ANC) is the total number of neutrophils (segmented neutrophils plus band forms of neutrophils) your child has to fight a bacterial or fungal infection. A normal ANC is greater than 1,500. And a low ANC is called neutropenia.

To find out what your child’s ANC value is, simply add the percentage of segs plus the percentage of bands and multiply the number by the WBC count. For example, if your child’s WBC is 4,000 and he has 20 percent segs and 10 percent bands:

Multiply the WBC number by the percentage or decimal:

Your child’s ANC would be 1,200.

Sometimes when your child’s ANC is low, it may be necessary to avoid some activities. You will need to watch for a rise in your child’s temperature and call the oncology service when it is over 100.4 degrees Fahrenheit or higher.

In some cases when the ANC remains very low, a medicine known as Granulocyte-Colony Stimulating Factor, or G-CSF, may be given to help the ANC count to rise. This medication is given to stimulate the bone marrow to produce more neutrophils. Initially, chemotherapy and/or radiation, may cause your child’s ANC to drop as low as zero.

If your child is in the hospital and his ANC is less than 500, he will be placed in protective isolation. This is to protect him from being exposed to possible infections. (However, most of the infections children get are caused by normal bacteria and fungi that live in or on your child’s body.) Protective isolation means your child will have a private room and the door will remain closed. People will need to wash their hands as they go into or out of the room. People with colds or the flu will not be able to visit your child.

After chemotherapy, radiation, or bone marrow transplant, your child’s ANC will slowly increase, showing the bone marrow is recovering and immune function is returning.

Temperature

It is important for you to check your child’s temperature if her body feels warm or if she does not feel well. Digital thermometers are acceptable. When taking a temperature by mouth, your child must keep the thermometer under her tongue with his lips closed.

Do not give your child any cold or hot drinks 30 minutes before you take her temperature, because this will alter the result you obtain. You can also put the thermometer under the child’s arm. Hold that arm close to the body. When you report the actual reading to your child’s physician, tell him or her the method (armpit, mouth) you used to take the temperature.

You should not check your child’s temperature rectally. This can result in rectal tears, bleeding, or infections.

Follow the manufacturers’ directions when taking your child’s temperature. Tell the nurse if you do not have a thermometer at home or if you need help reading the thermometer.

Activity

When your child’s ANC is low he may not be allowed to attend school. You may want to stay away from large crowds of people (e.g., church, shopping centers). Please check with your child’s care providers about appropriate activities when your child’s blood counts are low. Always avoid contact with individuals who are ill.

Emotional Care

When some of your child’s activities are restricted she may be upset. In simple terms for her age, explain why this is necessary. Your child may need some extra attention and support from her family during these times.

Medication

No medication should be given to your child unless it has been approved by the oncology care team.

Communication

You should call your physician, nurse or the oncologist on call immediately if your child has:

• A single temperature greater than or equal to 100.4 degrees Fahrenheit in a 12-hour period.
• Cough
• Pain in the rectal area
• Other signs and symptoms of infection

If your child has not had chicken pox or the chicken pox vaccine and is around someone who has chicken pox, call your physician or nurse within 24 hours. Make sure your child’s teacher and school nurse notify you if your child has been exposed to anyone in the class who has chicken pox or shingles. Call oncology at 513-517-2234 or call 513-636-4200 and ask for the oncologist on-call to be paged.

Anemia

When your child’s hemoglobin (Hgb) is low, it is called anemia. Anemia can be a side effect of chemotherapy or radiation. When your child is anemic he may tire easily or lack energy, feel weak, be irritable, look pale (especially around the lips and fingernails), have headaches and/or feel dizzy. In severe cases your child may breathe very quickly with small breaths or feel confused. You should call your child’s physician or nurse when you notice signs and symptoms of anemia. Your child’s physician will be checking your child’s blood counts regularly.

If he is anemic, he may need a transfusion of red blood cells to increase his ability to deliver oxygen to the body tissues.

Vitamins with or without iron will not correct this type of anemia. Do not give vitamins or iron unless you discuss this with your child’s physician.

Low Platelet Counts

A low platelet count (thrombocytopenia) can be the result of chemotherapy, radiation, or bone marrow disease. If your child has a low platelet count, you may see any of the following signs and symptoms:

• Bleeding from the gums
• Nosebleeds
• Increased bruising
• Dark, loose stools or blood in the stool
• Blood in the urine (red or brown color)
• Red / purple spots on the skin (petechiae)
• Heavy menstrual periods
• Headache

Your child’s blood counts will be checked frequently while he is receiving cancer treatment. He may receive a platelet transfusion when his counts are too low or if he has bleeding problems.

Activity

Your child should avoid contact sports and activities such as biking, skateboarding, skating and wrestling when his platelet count is low. Your child’s care team can tell you what activities should be avoided and what activities are safe.

Personal Care

When your child’s platelet count is low, use a soft toothbrush or Toothette for brushing teeth to avoid gum bleeds.

Medication

Your child should avoid the use of drugs such as ibuprofen, aspirin, or aspirin-containing medications. The doctor may order stool softeners such as Colace and Senokot to prevent constipation and hard stools, which can cause small tears and bleeding in the soft tissue of the anal area.

Safety

Do not take rectal temperatures or give suppositories or enemas to your child. No intramuscular injections are to be given without asking your child’s physician. If your child should have a nosebleed, apply pressure by pinching the nose for 10 minutes. If your child gets a cut, apply pressure over the cut for five minutes. Call your child’s oncologist if the bleeding does not stop.

Communication

You should call your physician, nurse, or the oncologist on-call immediately when your child:

• Has bright red blood in the stool or very dark, foul smelling stool
• Continues to have a nosebleed after you have applied pressure for 10 minutes
• Cuts herself and the bleeding does not stop after putting pressure over the site for five minutes
• Has an increase in bruising, red spots on the skin, increase in menstrual flow or blood in urine
• Complains of a severe headache, sudden vomiting or change in level of alertness

Blood Cell Markers Chart

Complete blood count – interpretation of results

26
Apr

Content:

• Why is a general blood test prescribed?
• When is a general blood test required?
• How a complete blood count is done: preparation
• Complete blood count – interpretation of results

https://www. youtube.com/watch?v=uCUr-tUQRgc

Why is a general blood test prescribed?

Complete blood count is the most common method of examining the human body, it allows the doctor to determine the causes of the patient’s ailments, which can be expressed in (general weakness, fever, dizziness, persistent or recurrent pain, and much more). The analysis can show the doctor that processes are occurring in the human body that are caused by infections, viruses, or any other inflammatory process, and it will also show if there are malignant neoplasms in the human body and whether the symptoms are caused by a viral infection.

When is it necessary to take a general blood test?

This analysis is the most common study and is used everywhere for the primary diagnosis of the state of the human body. A complete blood count must be taken upon admission to the hospital, at the annual medical examination and at the appointment of a doctor to assess health and identify the cause of the disease.

Let’s list just a few conditions of the body when the analysis is indicated for delivery:

• various blood diseases;
• pathology of the red bone marrow.
• iron deficiency anemia;
• malignant neoplasms;
• all possible inflammatory and infectious diseases;

If a patient suffers from chronic diseases and has symptoms that indicate that the systems and organs of the body are not working properly, then in these cases a complete blood count is strictly indicated.

How a complete blood count is done: preparation

A general (clinical) blood test is one of the most common examination methods, and each of us has taken it more than once in our lives. In order to donate blood correctly, you need a doctor’s appointment from which we will understand what kind of blood we will be taking. Usually, blood is taken either from a vein or from a finger. Blood from a vein is called venous, and blood from a finger is called capillary. In order to donate blood for analysis, we need to eat and go to bed in the evening, and when we wake up in the morning we don’t eat (you can drink plain water, but no more), we go to the laboratory and take the test. Before this, it is important not to eat or drink anything that can affect your blood so as not to distort the result and not mislead the doctor about the state of your body. Blood sampling for general analysis is taken from a finger (usually from the ring finger), the fingertip is pierced with a special sterile instrument – a scarifier, and a drop of blood appears from the resulting wound. Blood from a finger is collected using a small pipette into a vessel or using a special vacuum tube. Sometimes venous blood is also used for analysis, which is taken from a vein.

Remember that wrong diagnosis leads to wrong treatment!

The collected biomaterial (blood) is subjected to several studies: counting the number of blood cells – this is done using a microscope or special analyzers (hematological or biochemical), measuring the level of hemoglobin, determining the ESR. On the analyzers, all parameters are automatically determined, which increases the accuracy and speed of obtaining the result. For example: hematology analyzers for complete blood count – Mindray BC-3000 Plus, Mindray BC-3600, Mindray BC-5300, Mindray BC-6800; Analyzers are used to determine biochemical parameters – Mindray BS-120, Mindray BS-240Pro, Mindray BS-380 and others.

The interpretation of the general blood test is carried out by the attending physician, however, you can evaluate the main blood parameters yourself.

Complete blood count – interpretation of results

Deciphering the complete blood count is usually done by the attending physician, but you yourself can use this article to understand what is behind the numbers indicated in the analysis and understand whether they are normal or there are deviations from the norm. Modern laboratories are equipped with specialized equipment (blood analyzers), which automatically determine the main blood parameters. Automatic laboratory systems, after their work, issue the results of the analysis in the form of a printout and display the result on the display of the device, the resulting printout displays the main blood parameters, indicated by abbreviations in English and specific digital values.

The table below will present the main indicators of the general blood test, their corresponding English abbreviations and norms.

Red blood cell count (RBC)
Hemoglobin (HGB, Hb)
Hematocrit (HCT)
Red blood cell distribution width (RDWc)
Mean erythrocyte volume (MCV)
Mean erythrocyte hemoglobin (MCH)
Mean erythrocyte hemoglobin concentration (MCHC)
Platelet count (PLT)
Leukocyte count (WBC)
Lymphocyte count (LYM, LY%)
The content of a mixture of monocytes, eosinophils, basophils and immature cells (MID, MXD)
The number of granulocytes (GRA, GRAN)
The number of monocytes (MON)
Erythrocyte sedimentation rate, ESR, ESR.
Red blood cell count (RBC)

(RBC – English abbreviation red blood cell count – the number of red blood cells).

What does this mean?

Red blood cells perform the important function of supplying the tissues of the body with oxygen, as well as removing carbon dioxide from the tissues, which is then excreted through the lungs. If the level of red blood cells is below normal (anemia), the body receives insufficient amounts of oxygen. If the level of red blood cells is higher than normal (polycythemia, or erythrocytosis), there is a high risk that red blood cells stick together and block the movement of blood through the vessels (thrombosis).

Norm:

for Men – 4.0-5.0 x 10 to the 12th degree / l

for Women – 3.9-4.7 x 10 to the 12th degree / l

for Children – 3.8-5.5 x 10 to the 12th degree / l

Hemoglobin (HGB, Hb)

Hemoglobin is a special protein found in red blood cells and is responsible for transporting oxygen to organs. A decrease in hemoglobin levels (anemia) leads to oxygen starvation of the body. An increase in hemoglobin levels, as a rule, indicates a high number of red blood cells, or dehydration.

Norm:

Values ​​— 120 — 160 g/l

Hematocrit (HCT)

Hematocrit is an indicator that reflects how much blood is occupied by red blood cells. The hematocrit is usually expressed as a percentage: for example, a hematocrit (HCT) of 39% means that 39% of the blood volume is represented by red blood cells. Elevated hematocrit occurs with erythrocytosis (increased number of red blood cells in the blood), as well as with dehydration. A decrease in hematocrit indicates anemia (a decrease in the level of red blood cells in the blood), or an increase in the amount of the liquid part of the blood.

Norm:

for Men – 40 – 52%

for Women – 36 – 48%

for Women – 35 – 45%

RBC distribution width (RDWc)

Red blood cell distribution width is an indicator that indicates how much red blood cells differ in size from each other. If both large and small red blood cells are present in the blood, the width of the distribution will be higher, this condition is called anisocytosis. Anisocytosis is a sign of iron deficiency and other types of anemia.

Norm:

11.5 – 14.5%

Mean cell volume (MCV)

The mean volume of red blood cells allows the physician to obtain information about the size of the red blood cell. Mean cell volume (MCV) is expressed in femtoliters (fl) or cubic micrometers (µm3). Red blood cells with a small average volume are found in microcytic anemia, iron deficiency anemia, etc. Red blood cells with an increased average volume are found in megaloblastic anemia (anemia that develops when there is a deficiency of vitamin B12 or folic acid in the body).

Norm:

80 – 100 fl

Mean erythrocyte hemoglobin (MCH)

The average hemoglobin per red blood cell allows the doctor to determine how much hemoglobin is contained in one red blood cell. The mean erythrocyte hemoglobin content, MCH, is expressed in picograms (pg). A decrease in this indicator occurs with iron deficiency anemia, an increase in megaloblastic anemia (with a deficiency of vitamin B12 or folic acid).

Norm:

27 – 31 pg (pg)

Mean erythrocyte hemoglobin concentration (MCHC)

The average concentration of hemoglobin in an erythrocyte reflects how erythrocyte is saturated with hemoglobin. A decrease in this indicator occurs with iron deficiency anemia, as well as with thalassemia (a congenital blood disease). There is practically no increase in this indicator.

Norm:

30 – 370 g/l (g/l)

Platelet count (PLT)

Platelets are small plates of blood that are involved in the formation of a blood clot and prevent blood loss in case of damage to blood vessels. An increase in the level of platelets in the blood occurs in some blood diseases, as well as after operations, after the removal of the spleen. Decreased platelet levels occur in some congenital blood diseases, aplastic anemia (a malfunction of the bone marrow that produces blood cells), idiopathic thrombocytopenic purpura (destruction of platelets due to an overactive immune system), cirrhosis of the liver, etc.

Norm:

180 – 400 × 109/l

White blood cell count (WBC)

Leukocytes (white blood cells) protect the body from infections (bacteria, viruses, parasites). Leukocytes are larger than erythrocytes, but are found in the blood in much smaller quantities. A high level of white blood cells indicates the presence of a bacterial infection, and a decrease in the number of white blood cells occurs with certain medications, blood diseases, etc.

Norm:

4.0 – 9.0 × 10 to the 9th degree/l

Content of lymphocytes (LYM, LY%)

A lymphocyte is a type of white blood cell that is responsible for developing immunity and fighting germs and viruses. The number of lymphocytes in different analyzes can be presented as an absolute number (how many lymphocytes were found), or as a percentage (what percentage of the total number of leukocytes are lymphocytes). The absolute number of lymphocytes is usually denoted LYM# or LYM. The percentage of lymphocytes is referred to as LYM% or LY%. An increase in the number of lymphocytes (lymphocytosis) occurs in some infectious diseases (rubella, influenza, toxoplasmosis, infectious mononucleosis, viral hepatitis, etc.), as well as in blood diseases (chronic lymphocytic leukemia, etc.). A decrease in the number of lymphocytes (lymphopenia) occurs with severe chronic diseases, AIDS, kidney failure, taking certain drugs that suppress the immune system (corticosteroids, etc.).

Norm:

LY% 25-40%

LYM# 1.2 – 3.0 x 109/l (or 1.2-63.0 x 103/µl)

Content of a mixture of monocytes, eosinophils, basophils and immature cells (MID, MXD)

Monocytes, eosinophils, basophils and their precursors circulate in the blood in small amounts, so these cells are often combined into one group, which is designated as MID or MXD. This group can be expressed as a percentage of the total number of leukocytes (MXD%), or as an absolute number (MXD#, MID#). These types of blood cells also belong to leukocytes and perform important functions (the fight against parasites, bacteria, the development of allergic reactions, etc.). The absolute and percentage of this indicator increases if the number of one of the types of cells that make up it increases. To determine the nature of the changes, as a rule, the percentage of each type of cell (monocytes, eosinophils, basophils and their precursors) is studied.

Norm:

MID# (MID, MXD#) 0.2-0.8 x 109/L

MID% (MXD%) 5 – 10%

Granulocyte count (GRA, GRAN)

Granulocytes are white blood cells that contain granules (granular white blood cells). Granulocytes are represented by 3 types of cells: neutrophils, eosinophils and basophils. These cells are involved in the fight against infections, in inflammatory and allergic reactions. The number of granulocytes in various analyzes can be expressed in absolute terms (GRA#) and as a percentage of the total number of leukocytes (GRA%).

Granulocytes are usually elevated in the presence of inflammation in the body. Decreased granulocyte levels occur with aplastic anemia (loss of the ability of the bone marrow to produce blood cells), after taking certain medications, as well as with systemic lupus erythematosus (connective tissue disease), etc.

Norm:

GRA# 1.2-6.8 x 109/l (or 1.2-6.8 x 103/µl)

GRA% 47 – 72%

Monocyte count (MON)

Monocytes are leukocytes that, once in the vessels, soon leave them into the surrounding tissues, where they turn into macrophages (macrophages are cells that absorb and digest bacteria and dead cells of the body). The number of monocytes in various analyzes can be expressed in absolute terms (MON#) and as a percentage of the total number of leukocytes (MON%). An increased content of monocytes occurs in some infectious diseases (tuberculosis, infectious mononucleosis, syphilis, etc. ), rheumatoid arthritis, and blood diseases. A decrease in the level of monocytes occurs after major operations, taking drugs that suppress the immune system (corticosteroids, etc.).

Norm:

MON% 4 – 10%

MON# 0.1-0.7 x 109/l (or 0.1-0.7 x 103/µl)

Erythrocyte sedimentation rate, ESR, ESR.

The erythrocyte sedimentation rate is an indicator that indirectly reflects the content of proteins in the blood plasma. Elevated ESR indicates possible inflammation in the body due to increased levels of inflammatory proteins in the blood. In addition, an increase in ESR occurs with anemia, malignant tumors, etc. A decrease in ESR is rare and indicates an increased content of red blood cells in the blood (erythrocytosis), or other blood diseases.

Norm:

for Men – up to 10 mm/h

for Women – up to 15 mm/h

It should be noted that the indicated value of the blood test norm may differ slightly, this is due to the methods that are used in laboratories and adopted in a particular country. In any case, in order to be sure of the correct reading of the parameters and their interpretation, it is necessary to consult a doctor.

In a similar way, not only hematological blood tests are deciphered, but also blood biochemistry and analyzes of urine and feces.

Be Healthy!

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Indicators of clinical analysis of blood, lipid spectrum and their ratios in predicting obstructive lesions of the coronary arteries in patients with acute coronary syndrome without ST elevation | Tsivanyuk

Coronary heart disease (CHD) is the leading cause of morbidity and mortality in most countries of the world. Acute coronary syndrome (ACS) is one of the most common and dangerous clinical variants of IHD. It can be a consequence of both an exacerbation of chronic coronary artery disease and the first sign of coronary disease [1]. Non-ST-elevation ACS (NSTE-ACS), in contrast to ST-elevation ACS, is much more common (72% vs 28%), and its development is associated with a wider range of pathophysiological mechanisms [1][2]. The latter, in addition to incomplete occlusion of the epicardial coronary arteries (CA), include their spasm, spontaneous dissection, myocardial bridges, takotsubo syndrome, and microvascular spasm [3][4]. The results of invasive coronary angiography (CAG) indicate that among patients with NSTE-ACS, cases of intact coronary arteries or their non-obstructive lesion (NCCA) occur in 13-58% of patients [5-7]. These data served as the basis for improving the technologies for pre-test diagnostics of obstructive coronary artery disease (OPKA), the introduction of which into clinical practice makes it possible to limit the cases of unreasonable use of CAG, reduce the unjustified risks of an invasive procedure and wasteful healthcare costs [8]. One of the solutions to this problem is to assess the predictive potential of clinical and laboratory data available in everyday clinical practice. Previously, the predictive value of certain indicators of a clinical blood test (CAC) was shown for assessing cardiovascular risk in various populations, incl. among patients with ACS [9][10]. This approach was based on well-known ideas about the role of blood cells in the implementation of typical pathological processes involved in atherosclerotic coronary remodeling [11][12]. In particular, the relationship between the content of leukocytes in the blood (WBC), the width of the distribution of erythrocytes (RDW), the average platelet volume (MPV) with adverse outcomes of coronary artery disease [10][13] has been established. The predictive effectiveness of the ratio of the level of neutrophils (NEUT) and the concentration of cholesterol (CH) of high density lipoproteins (HDL) for stratifying the risk of mortality in patients with ACS for 6 months was shown. observation horizon [14]. In chronic CAD, the ratio of monocytes (MON) to HDL cholesterol was an independent predictor of adverse cardiovascular events, including acute myocardial infarction (MI) and unstable angina [15]. The immune-inflammatory index (systemic immuneinflammation index — SII), calculated as the product of platelet concentration (PLT) and the ratio of NEUT to lymphocytes (LYM), had an advantage over traditional risk factors for predicting cardiovascular complications in patients with coronary artery disease after percutaneous coronary interventions [12 ]. At the same time, there are only a few works that analyze the prognostic potential of clinical and laboratory parameters to assess the likelihood of AVCA in patients with NSTE-ACS before invasive CAG [16].

The aim of the study was to evaluate the predictive potential of BAC, lipid spectrum and their ratios for predicting APCA in patients with NSTE-ACS.

Material and methods

The study was carried out on the basis of the results of the analysis of indicators of the database “Prognostic evaluation of obstructive coronary artery disease in patients with non-ST-segment elevation acute coronary syndrome” ¹ , which provides information on 600 patients (374 men and 226 women ) aged 30 to 80 years with a median of 61 years and 95% confidence interval (CI) [60; 62], admitted in 2017-2021 to the Emergency Cardiology Department of the Vladivostok Clinical Hospital No. 1 with NSTE-ACS without proven myocardial necrosis according to the results of a study of highly sensitive cardiac troponin I on the RADIOMETER AQT90 FLEX analyzer (Denmark). The risk of death in the hospital was assessed using the GRACE scale [3]. Low risk occurred in 238 (40%) patients, medium risk in 332 (55%), and high risk in 30 (5%). All patients underwent invasive coronary angiography using the TOSHIBA iNFX-8000V angiographic system (Japan). Among the examined cohort, 2 groups of people were identified. The 1st of them included 360 (60%) patients with hemodynamically significant narrowing of the CA (≥50%) according to the results of CAG, the 2nd included 240 (40%) patients with NPCA (<50%). The clinical and functional status of patients before CAG was assessed by 33 indicators. The study was performed in accordance with Good Clinical Practice and the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee of the School of Medicine of the Far Eastern Federal University. Written informed consent was obtained from all participants.

Venous blood sampling from patients was carried out upon admission to the hospital with subsequent examination on a biochemical analyzer Mindray BS-800M (China). The levels of total cholesterol, HDL cholesterol, low density lipoprotein (LDL) cholesterol and triglycerides (TG) were determined. HOW it was carried out on a hematological analyzer Sysmex XN550 (Japan). The content of hemoglobin (Hb), erythrocytes (RBC), WBC, NEUT, LYM, MON, PLT, RBC sedimentation rate, hematocrit (HCT), thrombocrit, mean RBC volume (MCV), mean Hb content in RBC (MCH), mean concentration of Hb in erythrocyte mass (MCHC), RDW, MPV, platelet distribution width (PDW). The ratios of NEUT/LYM, PLT/LYM, MON/HDL-C, NEUT/HDL-C, HDL-C/LDL-C, LYM/HDL-C, TG/HDL-C were calculated. SII was calculated using the formula PLT*(NEUT/LYM) [12].

The end point of the study was represented by the GAAP in the form of a binary attribute (“absence” or “presence”). Input features — a subset of potential predictors were expressed as continuous and categorical variables. The methods of mathematical statistics and machine learning were used for data processing and analysis. The first of them were Fisher’s, Mann-Whitney’s, Chi-square (χ ² ) tests and one-way logistic regression (LR). The second is multifactorial LR (MLR). The models were developed using only one of the correlated variables in their structure to eliminate the problem of multicollinearity.

Statistical significance of features and hypothesis testing was confirmed by p-value <0.05. The quality of the models was assessed using 4 metrics: area under the ROC curve (AUC), accuracy (Ac), sensitivity (Se), and specificity (Sp).

The study design included 4 stages. At the first of them, in order to identify potential predictors linearly associated with OPCA, a statistical analysis of 33 factors was carried out in the comparison groups. For continuous variables, the Mann-Whitney test was used, and for categorical variables, χ ² . Odds ratios (ORs) and their 95% CIs were calculated by Fisher’s exact test. At the second stage, on the basis of the LR, the threshold values ​​of the factors with the greatest predictive potential were identified. The determination of prognostically significant ranges was carried out with a testing step of 0.05-0.1 arb. units for various indicators. The selection criteria corresponded to the limits of the values ​​of the factors, the p-value of which had a minimum value. At the fourth stage, using MLR on a training set (9/10 patients), predictive models of OPCA were developed, followed by cross-validation using the K-Fold method on a test set, which was performed 10 times on non-overlapping samples of 60 people (1/10) in each . Data analysis and model development were performed in R languages ​​in the R-studio and Python environment. The work was supported in part by grants from the Russian Foundation for Basic Research within the framework of scientific projects No. 1929-01077 and No. 20-37-

.

Results

Intergroup analysis of 33 factors characterizing the clinical and functional status of patients showed significant differences in 17 of them (Table 1). At the same time, the maximum level of statistical significance was recorded for indicators of gender (male), HDL-C, as well as the ratios of NEUT/HDL-C and HDL-C/LDL-C (p<0.0001). WBC and NEUT (p=0.0002), LDL-C (p=0.0003), MON/HDL-C ratio (p=0.0002) were distinguished by a high degree of significance. Less noticeable, but statistically significant intergroup differences were associated with the percentage of LYM (p=0.01) and NEUT (p=0.03) in blood, the ratio of NEUT/LYM (p=0.02) and SII (p=0, 02). According to the preliminary analysis, the age of the examined, Hb, RBC, PLT, erythrocyte sedimentation rate, HCT, MCV, MCH, MCHC, RDW, MPV, PDW, thrombocrit, MON%, LYM, PLT/LYM did not have a linear relationship with TCA.

Table 1

Indicators of AS, lipid spectrum and their ratios in patients with NSTE-ACS in comparison groups (Me, 95% CI)

900 57 Abbreviations: NPKA — non-obstructive coronary artery disease, OPKA — obstructive coronary artery disease, total cholesterol, ESR — erythrocyte sedimentation rate, TG — triglycerides, HDL cholesterol — high density lipoprotein cholesterol, LDL cholesterol — low density lipoprotein cholesterol, Hb — hemoglobin, HCT — hematocrit, LYM — lymphocytes, MCH — mean erythrocyte hemoglobin content, MCHC — mean hemoglobin concentration in erythrocyte mass, MCV — mean erythrocyte volume, MON — monocytes, MPV — mean platelet volume, NEUT — neutrophils, PCT — thrombocrit, PDW — platelet distribution width, PLT — platelets, RBC — erythrocytes, RDW — erythrocyte distribution width, SII — systemic immune-inflammation index, WBC — leukocytes.

At the second stage of the study, using a single-factor LR, among the previously selected 17 indicators, threshold values ​​were identified, the deviation from which led to an increase in their predictive potential (Table 2). The results of the analysis made it possible to identify age ranges for men (>55 years) and women (>65 years), belonging to which increased the likelihood of APCA (OR = 1.7, p = 0.01). Prognostically significant criterion boundaries were also established for individual HOW indicators. Thus, in patients with WBC>10 x10 ⁹ /l the probability of detecting a stenosing lesion of the coronary artery increased by more than 2 times (OR = 2.2, p=0.004), and the content of MON >0.63 x10 ⁹ /l increased the risk of AVCA by 3.2 times ( p<0.0001). With an increase in the level of NEUT >6.3 x10 ⁹ /l, the probability of APCA increased by 2.3 times (p=0.009), and with a decrease in LYM <19% — by 2.8 times (p=0.009). A comparable risk of ATCA was associated with lipid metabolism disorders, manifested by a decrease in HDL-C ≤1. 1 mmol/l (OR =2.4, p=0.0002), an increase in LDL-C >3.5 mmol/L (OR =2 .1, p=0.0004), total cholesterol ≥5.9mmol/l (OR = 2.0, p=0.001), TG ≥1.6 mmol/l (OR = 1.75, p=0.006). Similar OR values ​​were associated with TG/HDL-C ratios ≥1.5 arb. units (OR =1.75, p=0.009), HDL-C/ LDL-C <0.3 arb. units (OR=2.5, p<0.0001). The risk of ATCA increased significantly with an increase in MON/HDL-C >0.8 arb. units (OR =3.6, p=0.001), NEUT/HDL-C >5.7 arb. units (OR =3.7, p=0.0007), LYM/HDL-C >1.7 arb. units (OR =2.4, p=0.002) and SII ≥1000 arb. units (OR=2.8, p=0.02).

Table 2

Threshold range of potential predictors of ATCA based on univariate models LR

Abbreviations: CI — confidence interval, NCCA — non-obstructive coronary artery disease, ATCA — obstructive coronary artery disease, TC — total cholesterol, OR is the odds ratio, TG — triglycerides, HDL cholesterol — high density lipoprotein cholesterol, LDL cholesterol — low density lipoprotein cholesterol, AUC — area under the ROC curve, HCT — hematocrit, LYM — lymphocytes, MON — monocytes, NEUT — neutrophils, SII — immuno-inflammatory index ( systemic immune-inflammation index), WBC – leukocytes.

At the third stage of the study, based on the MLR method, predictive models were developed to assess the likelihood of AVCA before invasive CAG (Table 3). When constructing the models, we used the Best Subset Selection algorithm, which made it possible to identify a combination of potential predictors of the BCA with the best predictive potential. It included 3 categorical measures (age >55 years for men and >65 years for women, HDL-C/LDL-C <0.3 AU and SII ≥1000 AU) that were used as baselines. predictors in all developed models. The step-by-step inclusion of other factors in their structure led to an increase or decrease in only individual quality metrics. Their maximum rise was fixed in the model (9) with a combination of 8 categorical features, where, in addition to the basic predictors, LYM <19%, HCT >49%, MON/HDL-C >0.8 arb. units, NEUT/HDL cholesterol >5.7 arb. units and NEUT/LYM >3 arb. units This model had the best ratio of quality criteria: AUC – 0.80, Ac – 0.76, Se – 0. 78 and Sp – 0.79. Predictive algorithms that included combinations of other predictors had less predictive value. Table 3

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Note: * – indicator values ​​are indicated in categorical form.
Abbreviations: MLR — multivariate logistic regression, TG — triglycerides, HDL cholesterol — high density lipoprotein cholesterol, LDL cholesterol — low density lipoprotein cholesterol, Ac — accuracy (accuracy), AUC — area under the ROC curve, HCT — hematocrit, LYM – lymphocytes, MON – monocytes, NEUT – neutrophils, Se – sensitivity (sensitivity), SII – immuno-inflammatory index (systemic immune-inflammation index), Sp – specificity (specificity), WBC – leukocytes.

The relative contribution of various predictors to the implementation of the endpoint of the study was determined by sequentially eliminating individual factors from the structure of the best model and rebuilding it on the remaining ones. At the same time, the severity of the decrease in the AUC criterion indicated the prognostic value of the remote predictor (Fig. 1). Thus, when HDL/LDL cholesterol was excluded from the structure of the model, its accuracy in terms of AUC decreased by 38%. Removal of the age factor limited the accuracy of the model by 31%, MON/HDL-C by 14%, NEUT/HDL-C by 11%, LYM by 8%, and the sequential exclusion of SII, NEUT/LYM and HCT reduced AUC by 7%. %, 6% and 2%, respectively. Thus, the greatest contribution to the prognostic accuracy of ACA verification was associated with HDL-C/LDL-C <0.3 arb. units

Fig. 1. Relative contribution of individual predictors to endpoint realization, (%).
Abbreviations: HDL, high-density lipoprotein, LDL, low-density lipoprotein, cholesterol, cholesterol, HCT, hematocrit, LYM, lymphocytes, MON, monocytes, NEUT, neutrophils, SII, systemic immune-inflammation index

Discussion

Indicators of AS and lipid spectrum are among the most accessible indicators of the functional metabolic status of patients with coronary artery disease, which can be obtained in a typical clinical diagnostic laboratory. The assessment of their predictive value is increasingly used for predictive studies in clinical medicine. In the present work, based on a comprehensive analysis of BAC data, lipid spectrum, and their indexed values, we selected potential predictors for predicting AVCA in patients with NSTE-ACS before invasive coronary angiography. As a result of the analysis, it was found that among the HOW indicators, 3 factors in an isolated form (MON, LYM, HCT) and the NEUT/LYM ratio had the highest predictive value. Combined indices with similar predictive potential were represented by the ratio of lipid indicators (HDL-C/LDL-C) and their combination with BAC indicators (NEUT/HDL-C, MON/HDL-C, LYM/HDL-C) (Table 2).

It is known that the development of coronary artery disease is caused by atherosclerotic remodeling of the coronary arteries, the pathophysiological determinants of which are atherogenic disorders of lipid metabolism, chronic systemic inflammation, oxidative stress, endothelial dysfunction, degradation of the extracellular matrix, excessive proteolysis, etc. [10][12][14]. An increase in WBC levels and an imbalance in the ratio of NEUT and LYM are key indicators of the intensity of the inflammatory response in various pathological conditions, incl. OKS [12][17]. The NEUT/LYM ratio is one of the most well-known indicators of endogenous intoxication of various origins and a prognostic marker of adverse events in cardiovascular diseases [17]. In a recently published paper, NEUT scores >4.3 x10 ⁹ /l (OR =13.44, p=0.037) and NEUT/LYM >3.5 arb. units (OR =2.21, p<0.001) were identified as predictors of mortality in patients with coronary artery disease after coronary bypass surgery [18]. In another study, a decrease in the level of LYM to a criterion value of <1.06 x10 ⁹ /l was a predictor of death from any cause in patients in the intensive care unit (p<0.001) [19]. One of the hypotheses explaining the increase in the NEUT/LYM index in patients with circulatory pathology is associated with the translocation of LYM from the peripheral blood to the myocardium, followed by infiltration of foci of necrosis and inflammation, which was proven in cohorts of patients with extensive MI and acute heart failure [10]. The prognostic value of the imbalance of NEUT and LYM has been established in relation to postperfusion complications, incl. to assess the risk of acute lung injury in patients with coronary artery disease in the postoperative period of coronary artery bypass grafting with cardiopulmonary bypass [20]. In our work, LYM levels <19%, NEUT >6.3 x10 ⁹ /l and NEUT/LYM >3 arb. units were predictors of ATCA in models (4-8) and entered the structure of the prognostic model (9) with the best quality metrics (Table 3).

In recent years, studies have been published that present data on the relationship between the functional activity of PLT and adverse cardiovascular outcomes in patients with ACS [21]. At the same time, platelet-lymphocyte interactions are referred to as pathophysiological determinants of thrombosis, inflammation, and atherogenesis [17]. Increase in PLT/LYM >150 arb. units is associated with an unfavorable prognosis in patients with circulatory pathology [10]. In particular, the prognostic value of this index was shown in assessing the risk of mortality after myocardial infarction and in patients with occlusive diseases of peripheral arteries. In our study, the PLT and PLT/LYM indicators at the first stage of predictor selection were statistically insignificant (Table 1). However, PLT showed its predictive value when combined with NEUT and LYM in the SII index (Table 3). SII score >953 conv. units (OR = 3.26, p < 0.001) was identified as a predictor of adverse events, including MI and death over a 5-year follow-up horizon in patients with coronary artery disease after coronary artery bypass grafting on a beating heart [18]. In another study of similar design, SII >694 arb. units had a predictive value for assessing the likelihood of fatal complications after percutaneous coronary interventions [12]. In our work, the predictive potential of SII in relation to OPCA was realized at its level >1000 arb. units in the model (9).

An increase in whole blood viscosity contributes to a decrease in endothelial shear rate and an increase in arterial stiffness, which, in turn, accelerates the processes of their atherosclerotic remodeling [22]. One of the predictors of excessive blood viscosity is the HCT index. In [22], HCT >44.3% was a predictor of endothelial dysfunction and ACA in groups of patients with microvascular angina and coronary artery disease with atherosclerotic lesions of the epicardial arteries (p<0.001). In our study, HCT >49% had a close relationship with the TCA (OR = 3.6, p = 0.048) and was included in the structure of the best prognostic model (9).

The results of a number of studies indicate that the combined indices, including indicators of BAC and lipid spectrum, more accurately reflect the intensity of atherogenesis processes than isolated indicators [23]. The most studied prognostic markers of adverse outcomes in patients with ACS include the ratios of NEUT/HDL-C, LYM/HDL-C, MON/HDL-C, HDL-C/LDL-C, and TG/HDL-C [14-16][23]. Thus, in [14], it was shown that the NEUT/HDL cholesterol index is ≥10.4 arb. units had the best prognostic potential compared to other indices in predicting death at a horizon of 1. 4 years in patients with ACS due to occlusion of one of the epicardial coronary arteries (AUC=0.83, p<0.001). In another study, NEUT/HDL-C ≥5.74 arb. units (OR = 3.2; p<0.001) and MON/HDL-C ≥0.67 arb. units (OR = 2.2; p = 0.001) were predictors of death in patients over 65 years of age with myocardial infarction over a 2-year follow-up horizon [23]. In our work, indexed ratios, including a combination of BAC and lipid metabolism, were statistically significant at all stages of the selection of predictors, and the NEUT/HDL-C indices were >5.7 arb. units, MON/HDL-C>0.8 arb. units entered the model (9) with the best quality metrics. At the same time, HDL-C/LDL-C <0.3 arb. units was the basic predictor of this model, which was illustrated by its maximum contribution (38%) to the implementation of the endpoint. This fact confirms the leading role of indicators of atherogenic dyslipidemia in predicting ACA in patients with NSTE-ACS.

The limitations of the study are related to the need to validate GAAP models on independent samples.

Conclusion

Currently, there are no generally accepted models predicting ATCA in patients with NSTE-ACS. The scales used for this category of patients stratify the risk of death and MI at different observation horizons (GRACE, TIMI, PURSUIT, HEART, etc.). In the recommendations of the European Society of Cardiology for the diagnosis and treatment of chronic coronary syndrome (2019) it is proposed to use the Consortium CAD scale [24] to determine the pretest probability of the OPCA. In our study, an attempt was made to predict the severity of atherosclerotic remodeling of the coronary arteries in patients with NSTE-ACS before invasive coronary angiography. The developed prognostic algorithm for ATCA included 8 predictors: the age of patients, the ratio of HDL-C/LDL-C, MON/HDL-C, NEUT/HDL-C and NEUT/LYM, as well as the immune-inflammatory index, the content of lymphocytes in the blood <19% and hematocrit >49%. The greatest contribution to the implementation of the endpoint of the study was associated with 3 factors: HDL-C/LDL-C, age of patients, and MON/HDL-C. The influence of other factors on the risk of APCA was less noticeable.

Relations and activities. This work was supported in part by RFBR grants within the framework of scientific projects No. 20-37-

, No. 19-29-01077.

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